Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Dec 2011
Comparative StudyAnesthesia and perioperative management of patients who undergo transfemoral transcatheter aortic valve implantation: an observational study of general versus local/regional anesthesia in 125 consecutive patients.
To describe differences in intra- and postoperative care between general (GA) and local/regional anesthesia (LRA) in consecutive high-risk patients with aortic stenosis who underwent transfemoral transcatheter aortic valve implantation (TAVI). ⋯ This observational study suggests that LRA was associated with less intraoperative hemodynamic instability and significant shortening of the procedure and hospital stay. Changes in the anesthetic technique adapted to changes in TAVI interventional techniques and did not increase the rate of postoperative complications.
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J. Cardiothorac. Vasc. Anesth. · Dec 2011
Predictive value of the additive and logistic EuroSCOREs in patients undergoing aortic valve replacement.
The purpose of this study was to evaluate the accuracy of the additive and logistic EuroSCOREs in predicting the operative mortality in patients undergoing aortic valve replacement (AVR) with or without coronary artery bypass graft (CABG) surgery. ⋯ Although the additive and the logistic EuroSCOREs had good discriminatory power, they were not able to predict the actual operative mortality accurately. Both EuroSCOREs overestimated the operative mortality, especially in low-risk patients.
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J. Cardiothorac. Vasc. Anesth. · Dec 2011
Cryoablation of atrial fibrillation in cardiac surgery: outcomes and myocardial injury biomarkers.
Elevations of myocardial injury biomarkers after cardiac surgery without ablation of atrial fibrillation (AF) are related to perioperative myocardial ischemia and associated with an increased risk of mortality and cardiac events. However, there have not been any studies that examined the release of cardiac biomarkers after AF cryoablation procedures with concomitant cardiac surgery. The authors determined the levels of these biomarkers for 2 different procedures involving cryoablation and assessed their clinical implications. ⋯ Cryoablation in cardiac surgery causes the release of very high levels of myocardial injury biomarkers. The modified CM lesion causes a greater elevation of serum biomarker levels than the isolated LA maze procedure, but this increase does not seem to have an adverse effect on rhythm or overall outcome. Cryoablation is a safe and effective surgical treatment for AF.
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J. Cardiothorac. Vasc. Anesth. · Dec 2011
Use of recombinant activated factor VII for controlling refractory postoperative bleeding in children undergoing cardiac surgery with cardiopulmonary bypass.
To review the efficacy, safety, and dose of recombinant activated factor VII in off-label management of refractory bleeding in pediatric patients with congenital heart disease undergoing cardiac surgery with cardiopulmonary bypass. ⋯ Recombinant activated factor VII treatment reduced blood loss and transfusion requirements and prevented re-exploration in the majority (83.8%) of pediatric cardiac surgery patients. High doses were required to discontinue bleeding promptly in neonates, the majority of whom had hypoplastic left-heart syndrome. No treatment-related thrombotic events were observed.